Post Delivery Survey
Name
*
Did you experience any of the following during pregnancy or delivery? (Check all that apply.)
*
Hyperemesis
Hypertension
Gestational Diabetes
Preeclampsia
Depression/Anxiety
Preterm Labor
Pregnancy Loss/Miscarriage
Stillbirth
Not Applicable
Other
Did your baby have any of the following at birth? (Check all that apply)
*
Meconium Aspiration
Respiratory Distress (trouble breathing)
Jaundice
Withdrawal
Congenital Anomalies (birth defects)
Not Applicable
Other
If baby had a complication, did it result in a stay in the NICU?
Yes
No
Not Applicable
Do you believe that the meals helped you stay healthy during pregnancy?
*
Yes
Somewhat
No
Do you believe that the VHPGO program (dietitian appointments, videos, recipes, etc.) helped you stay healthy during pregnancy?
*
Yes
Somewhat
No
Do you believe that the VHPGO program helped you feel more supported during your pregnancy?
*
Yes
Somewhat
No
Do you believe that the VHPGO program helped you manage your stress levels during your pregnancy?
*
Yes
Somewhat
No
Do you believe that the VHPGO program helped you be more active during your pregnancy?
*
Yes
Somewhat
No
Do you believe that the VHPGO program helped you understand your choices for feeding your baby?
*
Yes
Somewhat
No
Have you attempted to breastfeed your baby?
*
Yes
No
How are you feeding your baby currently?
*
Breastfeeding
Formula feeding
Exclusive pumping
Combination
Has your doctor recommended any changes to your diet now that you have had your baby?
*
Yes
No
Other
Are you still receiving meal deliveries?
*
Yes
No
If yes, what percentage of the meals are you eating?
25 percent
50 percent
75 percent
100 percent
If no, when you were receiving meals, what percentage were you eating?
25 percent
50 percent
75 percent
100 percent
Email Address (to receive e-gift card):
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